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Posted on March 4, 2014 by American Diabetes Association
March is National Kidney Month, a time to raise awareness about the prevention and early detection of kidney disease. Did you know that diabetes is the leading cause of kidney failure? The good news is that managing your diabetes well can help improve your health outcomes.

So how does diabetes cause kidney disease? The process goes like this: When our bodies digest protein, the procedure creates waste products. In the kidneys, millions of tiny blood vessels with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.

Diabetes, both type 1 and type 2, can damage this system. High levels of blood glucose cause stress on the filtering system in the kidneys. After many years, they start to leak, and things like protein that are supposed to stay in the bloodstream are lost in the urine. Having small amounts of protein in the urine is called microalbuminuria. This damage happens without any symptoms.

In time, the kidneys stop working well. Waste products then start to build up in the blood. Finally, the kidneys fail. This failure, end-stage renal disease (ESRD), is very serious and requires a kidney transplant or dialysis.

Whew! Still with us? We hope so, because as mentioned above, the better a person keeps diabetes under control, the lower the chance of getting kidney disease. Research has shown that tight blood glucose control reduces the risk of microalbuminuria by one third. Other studies have suggested that tight control can even improve microalbuminuria.

Since there are usually no symptoms associated with early kidney failure, lab tests are essential. If you have diabetes, talk to your health care provider about how often you should be tested. This can be done by either a blood test or a urine test.click to view more

Osteoporosis, a loss of bone strength that raises the risk of fractures, is one of the most common and crippling ailments associated with aging in women. Increasingly, it is striking younger patients who have a host of other medical problems.

Researchers call it secondary osteoporosis. They are identifying a growing list of factors that contribute to bone deterioration, including chronic diseases and some of the powerful drugs used to treat them. Alone or in combination, disease and medication can interfere with the way the body naturally breaks down and rebuilds bone tissue, and how well it absorbs bone-building nutrients like calcium and Vitamin D.

Because there often are no symptoms as bone weakens, osteoporosis often hasn’t been diagnosed until a patient suffers a fractured bone.

Now, bone health experts are calling for greater efforts to identify patients earlier who are at risk for secondary osteoporosis, before their bones become more fragile and further raise their risk of injury and disability.

Secondary osteoporosis is increasingly being diagnosed in younger patients with cancer, celiac disease, rheumatoid arthritis and inflammatory bowel disease, as well as in people taking reflux medications, blood thinners and some depression drugs, researchers say. Patients are at risk of secondary osteoporosis after bariatric surgery for weight loss, as are those receiving hormonal treatments to prevent the recurrence of breast or prostate cancer.

Adverse effects of diabetes on bone health are starting to be recognized. Smoking, excessive alcohol use, eating disorders like anorexia nervosa and inactivity are also linked to declining bone mass.

According to a recent article in the New York Times, “Food Corporations Turn to Chefs in a Quest for Healthy Flavor,” Big Food companies like PepsiCo, Kellogg’s, and even fast food giants like Taco Bell are changing their ways in response to the increasing public demand for healthier food options. To improve their image as healthy food manufacturers, Big Food corporations have called upon top chefs to help them create healthy menu makeovers, infusing real, fresh, whole food into old recipe favorites.

Why is this happening now? Intense pressure brought on by politicians and their constituents (you and me!) has given these food manufacturers no choice but to respond to the public outcry for healthier food. It’s no longer enough for these companies to earn a profit by selling food that tastes good. People are beginning to use the power of the pocketbook to show these companies that the food they sell must also be nutritious.

That’s because people everywhere are waking up. They are beginning to see the dangers of genetically-modified ingredients and all the sugar, salt, and fats hidden in our food supply. From fancy restaurants to fast food chains, chefs are catching on that people want their food to make them feel good, not just while they are eating it but hours, days, and years afterward.

The U.S. Food and Drug Administration (FDA) recently approved nasal triamcinolone for over-the-counter use. This means that consumers will soon be able to go to their local drugstore and purchase a nasal steroid spray. Other brands will still be available by prescription. Previously, all nasal steroids were available only with a prescription so they required occasional monitoring by a medical provider.

There are benefits and risks that come along with the decision to allow access to over-the-counter corticosteroids. To help you make an informed decision, this article will describe the pros and cons. It will also explain the importance of working with your doctor even if the medicines may be obtained without a prescription.

What Are Nasal Steroids?
Nasal steroids are important medicines to help treat allergic rhinitis (hay fever). They are helpful in reducing nasal inflammation, nasal congestion, runny nose and sneezing.

Other medicines that are available to treat allergic rhinitis include oral antihistamines, nasal antihistamines, anti-leukotriene modifiers and nasal saline. Allergy immunotherapy (allergy shots) can also be given to improve the immune system to not react or desensitize itself to the allergens.

If you’re wondering which medicines and treatment strategies will work for you, your doctor will help you navigate the many options and will work with you to decide the best treatment plan.

What Are the Concerns with Using Nasal Steroids?
Although these medicines are safe under a medical provider’s care, they do have some potential risks and concerns:

1. Symptoms of allergic rhinitis can be similar to other ailments like sinus infections, viral colds, chronic sinus inflammation, sinus polyps, and in rare cases certain cancers and other serious problems. It is possible that consumers may treat the wrong condition and a more serious problem could go unnoticed.
2. Nasal steroids can lead to nose bleeds that can be very concerning to patients, which is why proper usage and technique are important. Your doctor can examine the nasal tissues to make sure no damage is occurring. A rare complication that can occur is a hole, or perforation, in the nasal septum (bone separating each nostril). To make sure this does not happen, individuals should be monitored and receive nasal exams.
3. Growth restriction is a well-known risk of using steroids, although topical steroids like nose sprays are less much risky than oral corticosteroids. Even so, every person is different and some are more sensitive than others. For that reason, height and weight should always be monitored.
4. Side effects involving the eyes, which include glaucoma and cataracts, are potential yet uncommon risk factors of topical steroids. Those at risk for these conditions should talk with their physician.
5. Since the medicine will be over-the-counter, you will likely have to purchase it “out of pocket,” which is the case with many antihistamines and heartburn medications. This could increase the amount of money you pay each year for health costs.

Unlike taking a pill, the way you use the nasal spray is important. As mentioned above, it is important to avoid spraying the medicine into the middle of the nose, the septum bone that separates the nostrils. Sometimes it helps to use a mirror, or have another person or doctor make sure this is being done correctly. If you do not use the medicine correctly, it may not work, or worse, could cause serious side effects.

As with all medications, the benefits and risks should be weighed before deciding on a treatment plan. When used properly, nasal steroid sprays can be very effective at treating allergies. It is just important to recognize that steroid nose sprays can create risks if not monitored or used correctly.

Your allergist is trained to help you navigate the best treatment course and monitor your health. He or she can explain the benefits and risks of these treatments and answer any concerns you may have. Together, you and your allergist can decide the best treatment plan.

The pros and cons of using the glycemic index for carb counting and meal planning

By Tracey Neithercott
February 2014

Carbs count. Eat too many and your blood glucose can spike. It’s the first lesson people with diabetes learn at diagnosis: Watch the number of carbohydrate grams you eat at each meal or snack. That’s all well and good, but what about the type of carbohydrate you choose to eat? Increasingly, researchers are asking that question. Their answer may surprise you.

The GI Revolution

Back in 1980, most people with diabetes were using carbohydrate exchange lists, and “glycemic index” was a term foreign to researchers, doctors, and patients alike. Scientists at the University of Toronto, led by David Jenkins, MD, PhD, DSc, began digging around in the body’s glucose response to different foods, and the term came into use. In a 1981 study published in The American Journal of Clinical Nutrition, the researchers listed what they called the glycemic index for 62 common foods.

The glycemic index (GI) measures the glucose response to a given number of grams of carbohydrate. Imagine a chart with a line representing glucose levels during the first two hours after you eat 50 grams of carbohydrate. The area under that line, when compared with results from a test using 50 grams of pure glucose, indicates a food’s glycemic index (graph, opposite). Foods with a high glycemic index have higher peaks and more area under the line than those with a low GI. The glycemic index, then, is a ranking of foods from zero to 100 based on blood glucose levels after eating. So 50 grams of a plain white baguette has a GI of 95 (and a taller graphed line) while 50 grams of an apple has a GI of 39 (and a shorter line).

“If you’re carb counting and if you have 20 grams of carbohydrate from an apple or a banana or rice, it’s [as if it’s] all the same,” says Thomas Wolever, BM, BCh, DM, PhD, coauthor of The New Glucose Revolution: The Authoritative Guide to the Glycemic Index—the Dietary Solution for Lifelong Health, professor in the Department of Nutritional Sciences at the University of Toronto, and coauthor of the 1981 glycemic index study. “But it’s not.”

You might imagine that the glycemic index would be useful for people with diabetes. Yet more than three decades after its discovery, the glycemic index still isn’t among the most-recommended meal-planning tools.

The Glycemic Load

Graphing Blood Glucose Response
To determine the glycemic index of foods, researchers plot glucose levels for two hours after subjects eat portions containing 50 grams of carbohydrate and compare the area under each line with that of pure glucose.

SOURCE: Adapted from The American Journal of Clinical Nutrition, January 2009

In its 2013 nutrition position statement, the American D
iabetes Association says picking low-GI foods over high-GI ones “may modestly improve glycemic control.” Yet despite the ADA’s slight encouragement, the recommendations note that while some studies showed drops in A1C (a measure of average glucose for the past two to three months) from following a low-GI diet, others found no blood glucose improvement at all.click to read more